The goal of this proposed grant is to develop a dynamic model of the impacts of alternative investments in treatment and prevention of cardiovascular disease (CVD) and use it to improve our knowledge of the ways in which alternative allocations of funds in the presence of policy resistance interact to produce an overall effectiveness associated with such allocations. The model will include downstream impacts of investments in research to develop new treatment and prevention interventions (where the research spending involves creating more effective interventions in the areas of prevention and treatment). It will also incorporate the effects of policy resistance that reduce the effectiveness of such interventions as individuals engage in less healthy behaviors as a result of improved prevention and treatment options. The model will be either a systems dynamics model (in which differential equations describe the flow of the population among alternative states of health as a function of specific patterns of spending and policy resistance) or a Markov model (in which the population flow among states is described probabilistically). In the course of conducting this research, we will produce several intermediate products that have stand-alone value as significant research advancements. They include: " A generic modeling structure representing the relationships between prevention and treatment research and intervention spending on future morbidity and mortality from CVD " An in-depth examination of the ways in which policy resistance affects attempts to reduce morbidity and mortality associated with CVD " Time series estimates of historical national expenditures on CVD prevention and treatment broken out into research and interventions " Time series estimates of the overall effectiveness of prevention and treatment interventions in recent years and the sensitivity of effectiveness to the level of previous research investments These intermediate products will be incorporated into the final model, which will be applied to determine the optimal allocation of health spending across the following four categories: (1) prevention interventions;(2) treatment interventions;(3) research into advancements in prevention interventions;(4) research into advancements in treatment interventions. We will demonstrate the impact of policy resistance on these model results and will develop a series of recommendations on how to best counteract the policy resistant problems identified and suggest an agenda for further research. Relevance While it is frequently claimed that current health care expenditures inappropriately emphasize treatment over prevention, there is little quantitative evidence to support the assertion. This issue is complicated by the presence of a class of policy resistance in which the benefits of new prevention or treatment measures are reduced through increases in unhealthy behaviors because the adverse consequences of such behaviors have been lessened. Our use of systems science methods to improve understanding of the tradeoffs associated with investments in prevention and treatment of cardiovascular disease, investments in research to improve such interventions, and the extent to which the impacts of such investments are affected by policy resistance can help inform the research agenda of the National Heart, Lung, and Blood Institute and other agencies, and help establish guidelines for an appropriate mix of treatment and prevention interventions. PUBLIC HEALTH RELEVANCE: Systems Science Methods for Addressing the Cardiovascular Disease Prevention - Treatment Trade-Off Project Narrative Relevance While it is frequently claimed that current health care expenditures inappropriately emphasize treatment over prevention;there is little quantitative evidence to support the assertion. This issue is complicated by the presence of a class of policy resistance in which the benefits of new prevention or treatment measures are reduced through increases in unhealthy behaviors because the adverse consequences of such behaviors have been lessened. Our use of systems science methods to improve understanding of the tradeoffs associated with investments in prevention and treatment of cardiovascular disease, investments in research to improve such interventions, and the extent to which the impacts of such investments are affected by policy resistance can help inform the research agenda of the National Heart, Lung, and Blood Institute and other agencies, and help establish guidelines for an appropriate mix of treatment and prevention interventions.